Research into protests and vigils that take place outside clinics and hospitals offering abortion care

Chapter seven: Discussion and conclusions

7.1. Introduction

This section brings together the findings from the research in relation to the three overarching research aims outlined in chapter one. To recap, these were:

• To understand the prevalence, frequency and scale of vigils and protests which occur outside of healthcare facilities providing abortions.
• To understand the impact of vigils and protests on patients’ ability to, and experiences of, accessing abortion services in Scotland.
• To understand the perspective and motivations of those involved in protests and/or vigils.

This chapter is divided into three sub-sections which focus on each of these research aims.

7.2. The prevalence, frequency and scale of vigils and protests

It has not been possible to provide a conclusive assessment of the prevalence and frequency of vigils and protests outside clinics and hospitals that provide abortion healthcare. As noted previously, this is in part due to the sometimes brief and transitory nature of protests and vigils, the way that these are arranged, coordinated and publicised, and that there is sometimes a low awareness of patterns related to vigils and protests among NHS staff. As may be anticipated, the frequency and prevalence also vary considerably across Scotland with those working in rural health boards such as NHS Borders and NHS Highland reporting not having witnessed any protest or vigil activity.

During the interviews, and from email correspondence with people involved in protests and vigils, it also became evident that some vigils and protests are unplanned and informal, sometimes comprising friendship groups or members of church groups.

Despite this, the research found some evidence to suggest that protests and vigils were occurring on a regular basis, particularly within urban areas such as Greater Glasgow and Clyde in which 79% of the 97 staff who responded to the survey reported having witnessed a protest or vigil in their current role. This is also consistent with our analysis of social media, which indicates 93% (n=28) of all protest/vigil activity recorded on social media between January and July 2023 occurred outside of the Queen Elizabeth University Hospital in Glasgow.

There is also evidence to suggest that the frequency of protests and vigils varies substantially. Our analysis of social media accounts of ‘counter-protest’ groups suggests that that there has been, on average, at least one protest/vigil occurring outside of a healthcare facility offering abortion care every 7 days in 2023, although this may be an under-estimation given the limitations of the data.

We note that of 5545 posts from the web and social media accounts of groups known to be actively involved in arranging protests and vigils in Scotland, there was no mention of planned protest or vigil dates. This indicates that arrangements for this type of activity tend to not be announced publicly. One exception to this is that the group 40 Days for Life sometimes announce their campaigns, and general activities on their website^[7]. This tends not to extend to dates, and locations of planned vigils.

The observations, and the social media accounts of organisations and individuals who campaign, indicates that vigils/protests are sporadic, but have some patterns. 36% (n=11) of all identified protests and vigils have occurred on a Tuesday/Wednesday and it is apparent from our observations that there is a relatively regular weekly vigil held at the Queen Elizabeth University Hospital in Glasgow, held for one hour, over lunch time, once a week.

The data indicates, however, that there are sporadic vigils and protests that occur on other occasions, and that this type of activity increases on the anniversary of the passing of the Abortion Act 1967 (October), and the implementation of the Abortion Act 1967 (April). The frequency of protests/vigils is also influenced by Lent, culminating in a large-scale protest/vigil on Palm Sunday, with over 100 people being seen to attend in April 2023 and March 2024^[8].

In relation to the scale of protests/vigils, we have been able to identify the numbers of people attending protests/vigils across the social media posts from counter-protest groups and individuals who are known to be actively posting about protests and vigils. The analysis of data from social media posts indicates an average of 11 people in attendance (range 2-76). In the observations conducted by the research team, however, numbers of people in attendance ranged from 2 to 10, with approximately 100 on Palm Sunday.

Observation of activity suggests that regular activities tend to be relatively quiet and feature a combination of silent witness and discussion with people who are approaching clinics/hospitals that provide abortion healthcare. However, some protests may have a different approach which can be louder, for example using megaphones and other intimidating approaches.

The triangulation of multiple data sources revealed that there are anomalies in terms of the reports and recording of vigil and protest activity in Scotland.

7.3. The impact of vigils and protests

As previously highlighted, given that we have been unable to include those who have experience of receiving abortion care, conclusions around the impact of protests/vigils should be considered with caution.

Despite this, it would appear that protest and vigil activity are perceived to negatively impact upon the care delivered by NHS staff. Of the 82 NHS staff responding to the survey who have witnessed a protest or vigil, 63% reported a negative or significantly negative impact on their work, with emotional impacts such as frustration, anger and anxiety being cited as having personal impacts. A small proportion (6%) reported changing their behaviour in accessing the sites as a result of protests/vigils, such as using a different entrance or removing their badges.

Focus group participants also identified resource implications for services, including extra time required to obtain consent as a result of patients feeling a need to justify their care choices, contacting patients to make them aware of activity on days they are due to attend for care, and the development of action plans to manage protests/vigils.

These findings align with existing research which reports that protests and vigils have a considerable impact upon staff, which led to some staff considering leaving the profession (Sifris and Penovic, 2018; O’Shea, 2023).

As discussed above, of the 82 staff who had witnessed a protest or vigil, 62% reported that at some point, patients had discussed protest/vigil activity in appointments. Whilst this does not provide first-hand accounts of any impacts, we suggest that it does place NHS staff in a unique position to have insight into the experiences of patients. Survey respondents and focus group participants identified a number of negative impacts for the patients they provided care for. This included observations that patients were sometimes upset, angry or distressed as a result of witnessing protests/vigils and that such activity outside of healthcare facilities was perceived to increase stigma related to accessing abortion care and, for some, increased concerns around anonymity. The potential for negative impacts on patients accessing other services or the wider public were also noted by the staff we spoke to.

However, 36% of staff who responded indicated no impact as a result of protests or vigils.

These findings align with the international literature presented in the rapid evidence review (Appendix two), where several studies have indicated that protests and vigils are a conduit for abortion stigma^[9], which can lead to long-term distress and mental health implications for women who are accessing abortion healthcare. A number of NHS staff reported that these impacted upon both the consent procedures and the time available for providing medical care in the appointment. Regarding consent, NHS staff were concerned that patients might be influenced by the guilt and judgement they might feel due to the presence of protestors. They also voiced concerns that the limited time available for appointments would be taken up by conversations about the protests or vigils, rather than focusing on the reason for the appointment.

A number of NHS staff also reported that they perceived there to be a negative impact on patient attendance as a result of protests and/or vigils. Staff reported that in their experience it was more common for patients to cancel, miss or rearrange appointments, either for abortion or adjacent services such as sexual health and gender services, on days when vigils or protests take place. However, it was not possible to test this finding through analysis of appointment data. It may be an important finding, given that existing literature demonstrates that delayed appointments can increase the risk of medical complications.

As Seewald et al. (2019) have noted, having encountered protesters or vigil attendees during abortion healthcare appointments can also lead to women feeling reluctant to seek help in circumstances where they begin to notice post-abortion complications. For this reason, the World Health Organisation (WHO) has called for there to be regulations imposed to reduce any stigma associated with reproductive and sexual healthcare to reduce gendered health inequalities (WHO, 2015).

7.4. The motivations of people who take part in protests and vigils outside clinics/hospitals that provide abortion healthcare

Motivation is an individualised phenomenon that differs from person to person. This makes it challenging to give a definitive answer as to what motivates people to take part in vigils or protests outside clinics/hospitals that provide abortion healthcare.

The research team sought to examine the perspectives of people who organise, and/or attend protests and vigils to better understand their motivations. Despite a multi-pronged approach to participant recruitment, however, there was a low response rate (n=4). The low response rate means that it is not possible to draw conclusions about motivation from the primary research.

To address some of these limitations, the research team conducted a digital and social media analysis, which is presented in chapter two of this report. The rapid evidence review (Appendix two) also examined motivations. Taken together, both research outputs provide some insights into the potential motivations of people who participate in, and/or who organise protests or vigils outside clinics and hospitals that provide abortion healthcare in Scotland.

These findings suggest that while motivations are individualised, there are some common themes. These are:

• A belief that human life begins at conception, and a desire to express this view as ‘truth’ to raise awareness.
• A belief that motherhood is the ‘natural’ and/or pre-destined state for a woman, and that she would not choose abortion if she knew of alternatives.
• The motivation linked to this belief is a motivation to provide alternatives, and to educate.
• A motivation to provide women emotional, financial and/or practical support to reduce the likelihood of her choosing abortion.
• A desire to engage in prayer and to be present at the site where abortions take place.
• A motivation to be present as a sign for women who may be unsure about their decision.

The findings presented in chapter two of this report, and in the rapid evidence review in Appendix two, however, suggest that while many people are motivated to participate in vigils to provide support and/or alternatives to women, the presence of those who are opposed to women’s decisions outside facilities that provide abortion healthcare can cause immediate, and long-term emotional and psychological harms (Arey, 2023; Lowe and Page, 2022; Sifris, Penovic and Henckels, 2020; Nguyen et al., 2018). Research suggests that even silent prayer can cause harm, particularly when accompanied by placards demarcating the activity as a vigil, because the presence of those opposing abortion can exacerbate and transmit abortion stigma (Seewald et al., 2019; Steinberg et al., 2016).